This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (61)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Yehuda Carmeli, MD, MPH; George Eliopoulos, MD; Essy Mozaffari, PharmD, MPH; Matthew Samore, MD

Arch Intern Med. 2002;162:2223-2228.

Background  The health and economic impact of vancomycin-resistant enterococci has not been quantified.

Methods  A retrospective matched cohort study was conducted comparing the outcomes of patients with vancomycin-resistant enterococci (cases) with those of control subjects matched for length of hospital stay until inclusion in the cohort, hospital location, and calendar date. The propensity to be a vancomycin-resistant enterococci case was modeled based on patient characteristics, and included in multivariable models to adjust for confounding. Analyses included the following: (1) conditional logistic regression for mortality, surgery, intensive care unit admission, and discharge to long-term care; (2) linear regression for the logarithm of cost; and (3) accelerated failure time model for length of stay.

Results  A total of 233 cases were compared with 647 controls. Groups were similar in age (mean, 62 years), sex (female, 47%), and length of stay before inclusion in the cohort (mean, 8.1 days), but differed in primary diagnosis and comorbidities, past infection or colonization with methicillin sodium–resistant Staphylococcus aureus or Clostridium difficile, and treatment with cephalosporins or metronidazole. These variables were included in the propensity score, which had good to excellent prediction. Outcomes for cases vs controls and adjusted risks (relative risks [RRs]) were as follows: (1) case fatality rate, 17% vs 6% (RR, 2.13; P = .04); (2) length of stay after inclusion in the cohort, 15.1 vs 8.5 days (RR, 1.73; P<.001); (3) hospital costs, $52 449 vs $31 915 (RR, 1.40; P<.001); (4) surgery after inclusion in the cohort, 18% vs 10% (RR, 2.74; P = .001); (5) intensive care unit admission after inclusion in the cohort, 25% vs 14% (RR, 3.47; P<.001); and (6) transfer to an institution, 51% vs 35% (RR, 2.01; P = .001).

Conclusion  Compared with a matched hospital population, a population with vancomycin-resistant enterococci was associated with severe adverse outcomes: increased mortality, morbidity, and costs.

From the Divisions of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (Drs Carmeli and Eliopoulos), and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Carmeli); Pharmacia Corp, Kalamazoo, Mich (Dr Mozaffari); and Division of Epidemiology, University Hospital, Salt Lake City, Utah (Dr Samore). Dr Carmeli, his laboratory, and studies that he has conducted during the past 4 years received grants, honoraria, travel support, and other forms of financial support from the following companies: Astra-Zeneca, London, England; Bayer Corp, West Haven, Conn; Biomedicum Ltd, Jerusalem, Israel; Bristol-Myers Squibb, Wallingford, Conn; Eli Lilly, Indianapolis, Ind; Merck & Co, Inc, Whitehouse Station, NJ; Neopharm Ltd, Petach Tikva, Israel; Pharmacia Corp, Peapack, NJ; Roche, Basel, Switzerland; SmithKline Beecham Pharmaceuticals, Philadelphia, Pa; and XTL Pharmaceuticals Ltd, Rehovot, Israel.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Patterns of Antimicrobial Use Among Nursing Home Residents With Advanced Dementia
D'Agata and Mitchell
Arch Intern Med 2008;168:357-362.
ABSTRACT | FULL TEXT